Country Villa Mar Vista Nrs Ct - Los Angeles Nursing Home
General Information
UPDATEFederal Provider Number
555726
Provider Name
COUNTRY VILLA MAR VISTA NRS CT
Provider Address
3966 MARCASEL AVE
LOS ANGELES, CA 90066
LOS ANGELES, CA 90066
Provider Phone Number
3103972372
Provider SSA County
200
Provider County Name
Los Angeles
Ownership Type
For profit - Partnership
Number of Certified Beds
68
Number of Residents in Certified Beds
63
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
RRT A PARTNERSHIP
Date First Approved to Provide Medicare and Medicaid services
1998-06-11
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
3
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.95714
Reported LPN Staffing Hours per Resident per Day
0.90952
Reported RN Staffing Hours per Resident per Day
0.99365
Reported Licensed Staffing Hours per Resident per Day
1.90317
Reported Total Nurse Staffing Hours per Resident per Day
3.86031
Reported Physical Therapist Staffing Hours per Resident Per Day
0.18175
Expected CNA Staffing Hours per Resident per Day
2.46969
Expected LPN Staffing Hours per Resident per Day
0.74705
Expected RN Staffing Hours per Resident per Day
1.55047
Expected Total Nurse Staffing Hours per Resident per Day
4.76721
Adjusted CNA Staffing Hours per Resident per Day
1.94447
Adjusted LPN Staffing Hours per Resident per Day
1.01051
Adjusted RN Staffing Hours per Resident per Day
0.47886
Adjusted Total Nurse Staffing Hours per Resident per Day
3.26407
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2014-12-15
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
Cycle 2 Total Number of Health Deficiencies
11
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
52
Cycle 2 Standard Health Survey Date
2013-08-25
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
21
Cycle 3 Number of Standard Health Deficiencies
19
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
108
Cycle 3 Standard Health Survey Date
2012-05-16
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
108
Total Weighted Health Survey Score
55.33300
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
4
Number of Fines
2
Total Amount of Fines in Dollars
11750
Number of Payment Denials
1
Total Number of Penalties
3
Location
Processing Date
2015-06-01
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Santa Monica Conv Ctr I
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SANTA MONICA CA 90404 | 3.7 miles away
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